Background

Intestinal metaplasia (IM) is a precancerous lesion that has been independently associated with gastric cancer development. The presence of IM in the preoperative study of Roux-n-Y gastric bypass (RYGB) raises question of whether or not remove the gastric remnant (GR) due to the impossibility of endoscopic surveillance.

Methods

Descriptive analysis of 6 consecutive cases of GR gastrectomy in RYGB from 2012 to 2021.

Results

Seven cases (85.7% women) with an age of 56(41-63) years and pre-surgical BMI of 38.9(34.8-43.2)Kg/m2. The endoscopy confirms IM in 71.4% of the patients. There are two cases which the indication for GR gastrectomy was due to multiple hyperplastic polyposis. Surgical time of the RYGB with GR resection was 140(95-260) minutes. Hospital stay was 2(2-6) days. No postoperative complications or mortality were observed at 30 days. Histological analysis of GR demonstrates IM and atrophic gastritis in 57.1% and 42.9%, respectively. Regarding gastric polyposis cases, one case reveals a well-differentiated neuroendocrine tumor (Ki67 1-2%) in one polyp, pT1NxM0, and the other one dismisses any malignancy. Weight loss results at 6 months of follow-up are equivalent to regular RYGB, BMI of 32.9(28.6-33.8)Kg/m2.

Conclusions

GR gastrectomy indication in RYGB must be individualized. IM is an independent risk factor and, given the impossibility of endoscopic surveillance, the addition of GR gastrectomy should be considered. It is a procedure that, in expert hands, is reproducible and safe with the same postoperative results as a regular RYGB. However, larger samples and long-term follow-up are needed to confirm these results.